title: Association of mitral annular calcification with endothelial dysfunction, carotid intima-media thickness and serum fetuin-A: an observational study.
abstract: OBJECTIVE
  Mitral annular calcification (MAC) is characterized by degenerative calcification of the mitral valve annulus. Atherosclerosis plays role in progression of MAC. Fetuin A is the inhibitor of pathological calcification. In the present study, we investigated the relationship between MAC and fetuin A with carotid intima media thickness (CIMT) and endothelial dysfunction.
  
  
  METHODS
  In this observational cross-sectional study, 40 patients with documented MAC on transthoracic echocardiography and 40 without MAC were included. All patients had coronary artery disease (CAD). Endothelial functions were assessed by brachial artery Doppler ultrasound (USG) and carotid artery Doppler USG. Serum fetuin-A level was also measured. Linear regression analysis and receiver operator curve analysis were performed.
  
  
  RESULTS
  Endothelial derived vasodilatory response (EDVR) was significantly decreased and CIMT value was increased in MAC group. There was a strong positive correlation between EDVR and serum fetuin-A value. There was a strong negative correlation between CIMT and EDVR, moderately negative correlation between CIMT and serum fetuin-A level. Simple linear regression analysis revealed that CIMT (β=0.367, p=0.001) and serum fetuin-A level (β=-0.291, p=0.009) were independent factors associated with MAC. The area under the curve (AUC) for serum fetuin-A level was 0.731 (95% 0.620-0.824) and AUC for CIMT was 0.724 (95% CI 0.613-0.818).
  
  
  CONCLUSIONS
  We observed that MAC is closely related with CIMT and serum fetuin-A level. Serum fetuin-A and CIMT can be used as independent markers in the diagnosis of MAC. We suggest that MAC can be used as an early determinant of CAD.
authors.affiliation: Clinic of Cardiology, Florence Nightingale Hospital, İstanbul-Turkey. saideaytekin@gmail.com.
authors.forename: Murat
authors.initials: M
authors.lastname: Ziyrek
authors.forename: Yelda
authors.initials: Y
authors.lastname: Tayyareci
authors.forename: Selen
authors.initials: S
authors.lastname: Yurdakul
authors.forename: Sükrü Taylan
authors.initials: ST
authors.lastname: Sahin
authors.forename: Ozlem
authors.initials: O
authors.lastname: Yıldırımtürk
authors.forename: Saide
authors.initials: S
authors.lastname: Aytekin
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood*; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D003430:Cross-Sectional Studies; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D011237:Predictive Value of Tests; D012372:ROC Curve; D012044:Regression Analysis; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography; D060749:alpha-2-HS-Glycoprotein / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D060749:alpha-2-HS-Glycoprotein